Provider Demographics
NPI:1033106844
Name:RICHTER, HOLLY MALLETT (MD)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:MALLETT
Last Name:RICHTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:HOLLY
Other - Middle Name:ANN
Other - Last Name:MALLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:538 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4456
Mailing Address - Country:US
Mailing Address - Phone:910-321-7337
Mailing Address - Fax:910-321-0003
Practice Address - Street 1:538 SANDHURST DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4426
Practice Address - Country:US
Practice Address - Phone:910-321-7337
Practice Address - Fax:910-321-0003
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001071814208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC127V3OtherBCBS
NC89127V3Medicaid
NC89127V3Medicaid